Medical Supplies

    The file room at my clinic is starting to look like a small pharmacy.  Andy Chiew, the pharmacist in the building, dropped by and he was impressed at our growing stock of pharmaceuticals.  

     I have not obtained enough antibiotic supplies.  I asked Andy to find out the least expensive generic source for an antibiotic in each of the basic classes and I will purchase a 1000 dose container of a half a dozen antibiotics.  Andy arranged for me to purchase these medications at cost, which is most appreciated, and then he generously offered to split the cost!  I was overwhelmed. Thank you Andy!
     Many physicians have generously donated supplies and others have been setting aside pharmaceuticals for us to pick up.  Michele Holtsbaum, my office manager, will visit half a dozen offices later today to pick up some of these supplies and she will do this again in March.   

     I purchased two very large duffel bags with wheels from MEC and expect to fill them both.  These versatile bags have shoulder straps on the back and can be carried as a pack on the shoulders, they have wheels on the bottom and can be rolled along the ground, and there are grips on three sides so they can be carried by hand.  I used one of these bags for Haiti last year and although very heavy when full, the bags were otherwise great.  

Learning Spanish

     I know enough Spanish to roughly follow a simple conversation and even to slowly read basic passages but my spoken Spanish is inadequate, especially for a professional medical intervention. During my visit to Nicaragua last October I had a driver who served as my interpreter.

     I have used interpreters in the United Arab Emirates and Haiti. 

     In the Emirates I was the Head of Pediatrics at the Royal Tawam Hospital and my position came with a full-time interpreter. I was exposed to a number of well-meaning male interpreters and I learned that most translate what they thought I should say rather than what I said. None of the available interpreters suited my needs. Many presented as very chauvinistic and condescending in their attitudes to the mothers and this was not acceptable. During the first month in Al Ain I met a nursing assistant from Palestine who was working on an adult service. He was a good interpreter who understood my need for a literal translation, for patience, and for a professional attitude. He was happy to interpret for me but this took quite a bit of haggling because he was not a designated interpreter. You would have thought that re-assigning him to my department should have been a very straightforward matter but the nursing department would not release him to my service unless I arranged to have his salary paid through my department and to incorporate a new salary without going though the conventional budget process and at the wrong time of the year turned out to be a major problem. However, I eventually succeeded and my clinical efforts were definitely better for my trouble.

     In Haiti the need for a good interpreter was painfully clear. On my third day a new interpreter arrived and he turned a difficult morning into an impossible morning. I might not speak Creole, but I can certainly read people. I would ask a question and the interpreter would provide an answer to another question. This happened so repeatedly that I started to speak very slowly and purposefully with him, the kindest and most preliminary way for me to let him know that I would try my best if he would try his; he was clearly impatient with the mothers and increasingly with me; I guess he felt that the failure to translate, his job, was either the mother’s problem or mine. After an hour or so, and with an increasing sense that he was just not interested in trying to connect with the mothers, I started to get impatient with him. “Is anything wrong,” I asked? “No,” he replied, but he laughed at me when he said this. His mind was clearly somewhere else and finally, when another translator became available, I asked him to leave. The new interpreter turned my morning around. The histories took a quarter of the time, the mother’s had the light of understanding in their eyes, and I was confident that I was offering good care.

     The clinic in Nicaragua does not have an interpreter who will routinely be available. I have offered to hire a local person with fluency in both languages but there are none available in this rural community. So, I need to learn Spanish.

     I researched the various methods to learn Spanish and I decided on The Rosetta Stone, a computer-learning program that incorporates audio with visual images. Last week I ordered the Spanish, Latin America version, Levels 1 to 5. I also ordered a well-known Medical Spanish textbook.  For the last two mornings I set my alarm for an hour earlier and I spent the time working on my Spanish. 


     My goal is to arrive in Nicaragua with rudimentary Spanish.  

More Donations!

     Every day I see 2 new children and 6 children who have returned for follow up.  I send a consultative note to the referring physician for each visit and every day 8 letters are faxed back to these doctors within 24 hours of the child's visit. 


     Two weeks ago I started to send a request for donations of medical supplies with each of these letters.  Almost every physician receives samples of various medications from pharmaceutical companies.  Many of these samples are used and many are thrown away on the expiry date.  My letter requested that my colleagues consider setting aside desirable medications for me to take to Nicaragua. 


     I did this before I left for Haiti last spring, but this time I started earlier and I will reach out farther into the Calgary medical community.  Michele Holstbaum, my assistant, will pick up the medications on specified days, once in February, and a second time in early March. 


     We will take all the medications out of the packages, sort them into categories (antibiotic, pain, asthma, etc), sort them again by specific medication, and sort them again by expiry date.  When the medications arrive in Nicaragua they will be ready to use in the most efficient way possible.  This is considerably better than the jumble of meds I took to Haiti in two duffle bags.  


     Last week we received donations or promises of donations from 

Dr. Susan Kinnie, 

Dr. Michael Guiffre,

Dr. Ashref Jeeva,

Dr. Patricia Bryden, 

Dr. Marilyn Lee, and

Dr. Aravind Subramanian.

     Many thanks to these colleagues for their help and for their gift to the children of Nicaragua. 

Thank you Pharmascience!

         Pharmascience donated 150 boxes of Electrolyte Gastro, which is ideal to rehydrate children with diarrhea.  Many thanks to Julia Keshen,

Product Manager for Pharmascience, and to Cathy Chan their local representative, for arranging this helpful donation.  Pharmascience is a Canadian Company founded by two pharmacists in 1983 and which now employs over 1300 people.

         Diarrhea is common in Nicaragua.  Diarrhea is one of the leading causes of death in children.  The cause of death is usually dehydration and oral or intravenous fluids can be a lifesaver. Thank you Pharmascience for a donation that might well save lives.

         Contaminated drinking water is often the source of the germs that cause diarrhea and access to safe drinking water is a big problem in Nicaragua.

         One major lesson I learned in Haiti was to make the treatment very simple for the family.  Giving a family some packets of rehydration powder and expecting them to mix the powder in water at home would not work.  The family either did not have access to safe water or could not afford bottled water, and even if they had water, they often could not read the instructions on the packets, and even if they could read the instructions, many would not mix the powder in the correct amount of water.  The solution was to purchase 1 liter bottles of water, mix the packets in the water, and to write simple directions in French about how much the child should drink, and to tape the instructions onto the bottle.  We never had enough water or powder so we were never able to give a family more than one day of rehydration solution.  Courtesy of Pharmascience and the water we will purchase in Managua, this should not be a problem for our Nicaragua trip.

         This donation started me thinking about the water situation in Nicaragua. 

         A five year-old child needs about 1.5 liters of water a day.  Where would a 5 year-old Nicaraguan child who lives in a rural area obtain 1.5 liters of fresh water that was safe to drink?

         There are community wells with variable quality and sanitation and family members often need to walk long distances for this water.  World Health Organization (WHO) data indicates that access to improved water supply in rural areas of Nicaragua increased from 46% in 1990 to 63% in 2004.  Access to improved sanitation in rural areas or Nicaragua increased from 24% in 1990 to 34% in 2004.  Going in the right direction.

         Rainwater is collected in cisterns during the 7-month May-to-November rainy season, but these sources are often not chlorinated or filtered and stagnant water that sits out in the heat is soon not safe.  In Haiti last spring I had a shower from a rooftop cistern and tadpoles came out of the pipe! 

         Lake Managua and Lake Nicaragua are large fresh water lakes but Lake Managua is polluted and the country has a very limited water pipeline infrastructure.  The country has salt water on both the Pacific and Caribbean coasts but desalination is not currently an option.

         Bottled water is available in commercial centers, costs about 30 cordobas ($1.35) for five gallons (19 liters), or about 7 cents a liter.  This doesn’t sound like much by Canadian standards, but to supply just the drinking needs for a family of two adults (2.5 liters per day per adult) and two children (1.5 liters per day per child), requires 8 liters of drinking water a day and this is more than 50 cents a day.  Many Nicaraguan families subsist on a dollar a day and paying this much for water is not possible. 

         Many Canadians take water for granted.  We shouldn’t.  Nicaraguan families don’t.  For them, living in a lush tropical rainforest, only 11 degrees north of the equator, there is water everywhere, but sometimes, like the Ancient Mariner, “Nor a drop to drink.” 

Time to Give Back!

Here I am,

finally,  

working as a Pediatrician

in a poor country.

I've wanted to do this all my life.

In 1974 I signed up with Save The Children

to work six months in Cambodia, 

but Pol Pot and a genocidal war

interfered with that project.

Then family, profession, and the years flowed by.

Now is my time. 

Last year, in March 2010,

I rearranged my practice

to help out in Haiti for two weeks.

You can read an abbreviated description

of my time in Haiti on my clinic website,

www.childrensclinic.ca.

I worked hard

and returned with conflicted emotions,

but with the certainty 

that I wanted to do more. 

In October 2010 I spent

ten days in Nicaragua

to scout out a new opportunity to help.

I will return to Nicaragua in March 2011

to work in a rural clinic

as a pediatrician.

I hope to sustain this dream come true. 

Life has smiled on me

but frowned on much of the world. 

Time to give back, time to help out. 

Nicaragua is the second poorest country

in the Americas,

and deserving of our help.

There are doctors in Nicaragua.

After the revolution, the government

established schools and medical clinics

in most of the major communities.

But there are not many doctors

and there are very few specialists.

A doctor in Nicaragua is paid $500 a month,

and they are rich

compared to the average worker

who makes less than $100 a month.

Time to give back!

If you would like to help,

If life has smiled on you

and you also desire to give back, 

if you can help in any way,

please contact us at

helpnicaraguachildren@gmail.com.

Thank you.

Lane Robson MD

www.childrensclinic.ca